Twice-weekly Workouts May be Best Medicine for Cognitive Decline

Cheryl Platzman Weinstock wrote . . . . . . . .

There’s little evidence that medications improve mild cognitive decline associated with aging, according to a new review of research, but doctors can recommend exercise with confidence.

Researchers reviewed 11,530 studies of so-called mild cognitive impairment (MCI), to see how many older people are affected and which interventions and lifestyle changes have been shown to improve symptoms.

MCI becomes increasingly common at older ages and is characterized by mild problems with thinking and memory that usually don’t interfere with daily life or independent function. People diagnosed with MCI are more likely, however, to go on to develop Alzheimer’s or other dementias than people without it.

Until now, said Ronald Petersen, the lead author of the new study and American Academy of Neurology (AAN) treatment guidelines, “Clinicians didn’t know what to do with these people. Now that we know that it’s a burgeoning condition we need to pay attention when folks come in and complain.”

Petersen, who directs the Mayo Clinic Alzheimer’s Disease Research Center in Rochester, Minnesota, and his coauthors found that between ages 60 and 64, 6.7 percent of people have MCI. In the 65-69 age group, that rises to 8.4 percent, and about 10 percent at ages 70-74, nearly 15 percent at 75-79 and just over 25 percent at ages 80 to 84.

When they looked at the use of drugs, such as cholinesterase inhibitors, they found “no high-quality evidence” that the medications work, according to the report in the journal Neurology.

Their analysis of studies looking at the effects of physical exercise on cognition did find a benefit, though. In one study involving 86 women with MCI, 70 to 80 years old, researchers found that twice-weekly resistance training for 26 weeks was more effective than aerobic training over the same time period at increasing what’s known as executive functioning. After completing the exercise regimen, the women were better able to plan, manage and organize their thoughts.

Based on their review, the authors updated a practice guideline for MCI to include, for the first time, a recommendation that people with the syndrome should exercise regularly as part of an overall approach to managing their symptoms.

“This is a rich area of study. I don’t think you can say that if you exercise 150 minutes a week you can push back cognitive decline a certain number of years,” Petersen said in a telephone interview. “We don’t know that for sure, but . . . physical exercise might be beneficial in slowing down the rate of cognitive decline since it has been shown to cause some stabilization or improvement of cognition.”

He thinks a combination of aerobic exercise and resistance training is likely best for MCI patients, but the data about its long-term effectiveness remains “scant.” He recommends that patients with MCI try to work up a sweat by walking briskly for 50 minutes, three times a week, because it might improve blood flow to the brain or induce enzymes to break down proteins that can build up into brain plaques.

Neurology researchers are hoping to develop more specific evidence-based guidelines on how much exercise and what kind is needed to potentially delay or prevent cognitive decline based on ongoing clinical trials, he noted.

The new AAN guideline, which is endorsed by the Alzheimer’s Association, also urges clinicians to discuss with their MCI patients the diagnosis, prognosis, long-term planning and the lack of evidence that drugs and dietary options, such as vitamins E and C, homocysteine-lowering B vitamins and flavonoid-containing drinks, are at all effective.

Petersen and his colleagues also analyzed five studies of brain-training interventions and found “insufficient evidence to support or refute the use of any individual cognitive intervention strategy.” Nevertheless, they conclude that doctors may recommend this approach because it might improve specific cognitive skills.

“Continuing to be cognitively and physically active is paramount for overall brain health,” noted Dr. Neelum T. Aggarwal of the Rush Alzheimer’s Disease Center in Chicago, who wasn’t involved in the review or guidelines.

Some cases of MCI are associated with reversible causes of cognitive impairment, including medication side effects, sleep apnea, depression and other medical conditions, so it’s important for patients to visit their healthcare provider at the first sign of memory problems, he said in a phone interview.

Source: Reuters


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Pharmacy Dispenses Fruit and Vegetables

Maddie Oatman wrote . . . . . . .

Six years ago, James Stancil, 62, a former long-haul trucker, decided to move from Iowa back to his hometown of San Francisco to live with his aging mother. There was just one problem: His enlarged heart, high blood pressure, and diabetes made his body so swollen he couldn’t get on an airplane. Doctors had to drain 75 pounds of fluid before he was well enough to fly. By the time he walked into a public health clinic near his mother’s house, his blood pressure was so high that “people were telling me, ‘You should be dead right about now,’” recalls Stancil, who’s African American and sports a white chinstrap beard. He was put on medications. He also met with a nutritionist, who urged him to cut down on salty, fatty foods like fried chicken and mac and cheese. After he learned to prepare his favorite dishes differently, his blood pressure plummeted; it’s now back to normal.

“Often we just pile on prescriptions and ignore the other half of the equation for wellness, which is food.”
Stancil no longer has to take so many pills. Yet thanks to a new program, he still frequents a pharmacy at Silver Avenue Family Health Center—only this one fills prescriptions for things like pears and squash. The so-called food pharmacy brings together the resources of a food pantry with the acumen of clinical nutritionists and the flair of a farmers market, mostly to tackle high blood pressure and diabetes. Patients who receive a referral can stop by for donated groceries, recipe demonstrations, and cooking tips. Four more of San Francisco’s primary care clinics will host food pharmacies by next year.

Meanwhile, diet-related diseases continue to spread: 1 in 3 adults in the United States have high blood pressure, elevating their risk for heart disease and stroke. More than 7 percent of people have diabetes, mostly Type 2, up from 4.4 percent in 2000. In 2012, the disease cost the country $176 billion in direct medical expenses, plus another $69 billion in decreased productivity. Analysts at Thomson Reuters calculated that reducing employee health risks such as high glucose and blood pressure by just 1 percent could save employers $83 to $103 per person annually. The program is part of a movement to prevent and manage conditions through diet, not pills. “Often we just pile on prescriptions and ignore the other half of the equation for wellness, which is food,” says the San Francisco public health department’s Dr. Rita Nguyen, who spearheaded the city’s food pharmacy project. A 2015 study in the Journal of Biomedical Education found that only about a quarter of medical students get the recommended 25 hours of nutrition education. And as Nguyen points out, doctors have a financial incentive not to specialize in primary care: They’re paid well to cut out cancer or freeze warts, but not to “spend 15 minutes talking to someone about their diet.”

Even with a doctor’s nudge, eating healthily is easier said than done for poor Americans. Fresh produce is often much more expensive than packaged and fast foods. Most of Nguyen’s patients are on Medicaid, and 65 percent of them lack reliable access to affordable food, a situation experts call “food insecurity.” Food-insecure populations also see higher rates of high blood pressure, high cholesterol, and diabetes.

San Francisco’s food pharmacies are some of a handful that have popped up around the country. Many were inspired by Boston Medical Center’s “preventative food pantry,” which opened in 2001 after doctors realized their patients struggled with food insecurity and its associated maladies and couldn’t afford to stock their fridges with fresh veggies and other perishables. The BMC food pantry’s 7,000 monthly visitors now enjoy produce from the hospital’s rooftop garden.

Measuring the impact of food pharmacies can be tricky, says BMC dietetic technician Latchman Hiralall, because patients rely on them only for some of their groceries. But early indicators are encouraging: After a three-month trial at one of San Francisco’s pharmacies, 75 percent of patients reported greater access to healthy foods; about half reported better blood sugar levels, and 38 percent reported lower blood pressure.

The morning I visited the Silver Avenue pharmacy, a sunlit room lined by long wooden tables and a small corner kitchen, a dietitian handed out cookies made from bananas and oats along with printed recipes to about 10 patients. The pharmacy hopes to attract 40 patients every week; currently it sees 10 to 20. Stancil, now a volunteer at the pharmacy, stood next to gleaming silver buckets of yellow onions and red apples. A broad man with close-cropped gray hair and a cane declined to take some fresh carrots. “You like coleslaw?” Stancil asked. “Oh, man—I love it. Carrots are in coleslaw?” the man responded, adding that he had never made it. Stancil nodded and said, “We can show you all that.”

Source: Mother Jones


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New Cancer Drug Shows Promise Against Wide Range of Tumors

A new drug that targets a genetic flaw common to most cancer cells is showing potency against many tumor types.

The preliminary trial of a drug called ulixertinib was conducted with 135 patients who had already failed treatments for one of a variety of advanced, solid tumors.

Researchers led by Dr. Ryan Sullivan, of Massachusetts General Hospital, said ulixertinib did seem to spur at least a “partial response” to the therapy or “disease stabilization,” regardless of cancer type.

“It was exciting to see responses in some patients,” said Sullivan, an oncologist and member of the Termeer Center for Targeted Therapies at the Boston hospital.

“The results of this study can be built upon to develop better treatment regimens for these patients,” he said in a news release from the American Association for Cancer Research (AACR).

One cancer specialist explained how ulixertinib works on the cellular level.

“It inhibits the MAPK/ERK pathway, which is a chain of proteins in the cell that communicates a signal from a receptor on the surface of the cell to the DNA in the nucleus of the cell,” said Dr. Maria Nieto.

“When one of the proteins in the pathway is mutated, it can become stuck in the ‘on’ or ‘off’ position, which is a necessary step in the development of many cancers,” said Nieto, a medical oncologist at Northwell Health’s Huntington Hospital in Huntington, N.Y.

Ulixertinib effectively inhibits this broken cellular pathway, and that inhibition “can be therapeutically exploited in multiple different cancers such as melanoma, lung, colon, and low-grade ovarian cancer,” she explained.

Sullivan said that because ulixertinib targets the “final regulator” in the MAPK/ERK pathway, it might avoid cancer cells’ typical resistance to drug treatment.

“A great number of cancers — including melanoma and lung cancers — have mutations in the MAPK/ERK pathway, and while current therapies target proteins in this cascade, many patients develop resistance to current drugs,” he explained.

“The common denominator in these failed therapies is that the cancer has found a way to activate ERK. Therefore, the development of ERK inhibitors is a crucial next step to target this aberrant pathway,” Sullivan said.

When it came to side effects, ulixertinib appeared to have a “tolerable” profile, with most issues not particularly severe, the researchers said. But this was still a small phase 1 trial, Sullivan noted, so larger trials are needed.

The study was funded by the drug’s developer, Biomed Valley Discoveries, and published in the AACR journal Cancer Discovery.

Dr. Stephanie Bernik is chief of surgical oncology at Lenox Hill Hospital in New York City. She agreed that the new medicine has great potential.

“Ulixertinib halts the message at the last stop before the signal can make it into the nucleus and creates a second roadblock, therefore halting growth of the cancer cell,” Bernik explained. “This kind of therapy shows great promise and allows drugs to work synergistically, making it much harder for the cancer cell to figure out a way to continue to multiply and spread.”

According to the study team, the U.S. Food and Drug Administration has fast-tracked ulixertinib for development and potential approval.

Source: HealthDay


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FDA Approves Pill with Sensor that Digitally Tracks if Patients have Ingested their Medication

The U.S. Food and Drug Administration today approved the first drug in the U.S. with a digital ingestion tracking system. Abilify MyCite (aripiprazole tablets with sensor) has an ingestible sensor embedded in the pill that records that the medication was taken. The product is approved for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder and for use as an add-on treatment for depression in adults.

The system works by sending a message from the pill’s sensor to a wearable patch. The patch transmits the information to a mobile application so that patients can track the ingestion of the medication on their smart phone. Patients can also permit their caregivers and physician to access the information through a web-based portal.

“Being able to track ingestion of medications prescribed for mental illness may be useful for some patients,” said Mitchell Mathis, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research. “The FDA supports the development and use of new technology in prescription drugs and is committed to working with companies to understand how technology might benefit patients and prescribers.”

It is important to note that Abilify MyCite’s prescribing information (labeling) notes that the ability of the product to improve patient compliance with their treatment regimen has not been shown. Abilify MyCite should not be used to track drug ingestion in “real-time” or during an emergency because detection may be delayed or may not occur.

Schizophrenia is a chronic, severe and disabling brain disorder. About 1 percent of Americans have this illness. Typically, symptoms are first seen in adults younger than 30 years of age. Symptoms of those with schizophrenia include hearing voices, believing other people are reading their minds or controlling their thoughts, and being suspicious or withdrawn. Bipolar disorder, also known as manic-depressive illness, is another brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks. The symptoms of bipolar disorder include alternating periods of depression and high or irritable mood, increased activity and restlessness, racing thoughts, talking fast, impulsive behavior and a decreased need for sleep.

Abilify MyCite contains a Boxed Warning alerting health care professionals that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Abilify MyCite is not approved to treat patients with dementia-related psychosis. The Boxed Warning also warns about an increased risk of suicidal thinking and behavior in children, adolescents and young adults taking antidepressants. The safety and effectiveness of Abilify MyCite have not been established in pediatric patients. Patients should be monitored for worsening and emergence of suicidal thoughts and behaviors. Abilify MyCite must be dispensed with a patient Medication Guide that describes important information about the drug’s uses and risks.

In the clinical trials for Abilify, the most common side effects reported by adults taking Abilify were nausea, vomiting, constipation, headache, dizziness, uncontrollable limb and body movements (akathisia), anxiety, insomnia, and restlessness. Skin irritation at the site of the MyCite patch placement may occur in some patients.

Prior to initial patient use of the product, the patient’s health care professional should facilitate use of the drug, patch and app to ensure the patient is capable and willing to use the system.

Abilify was first approved by the FDA in 2002 to treat schizophrenia. The ingestible sensor used in Abilify MyCite was first permitted for marketing by the FDA in 2012.

The FDA granted the approval of Abilify MyCite to Otsuka Pharmaceutical Co., Ltd. The sensor technology and patch are made by Proteus Digital Health.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Source: U.S. Food and Drug Administration

Common Heartburn Medicines May Link to Kidney Trouble

If you’re one of the millions of Americans who takes one of a class of anti-reflux meds such as Nexium, Prilosec and Prevacid, take heed: These drugs have been linked to higher odds of kidney trouble.

The study couldn’t prove cause-and-effect — it’s possible that folks who need these heartburn medicines are simply more prone to kidney disease for other reasons. But the review of data did show a link.

The medicines in question are called proton pump inhibitors (PPIs). They reduce stomach acid production and are among the most widely prescribed medications in the world.

According to a team led by Dr. Charat Thongprayoon, of Bassett Medical Center in Cooperstown, N.Y., recent research has suggested an increased risk of kidney problems for people who take the drugs, but those findings were inconsistent.

Probing deeper, the researchers reviewed data from five studies that included a total of nearly 537,000 people.

They found that people who took a PPI were a third more likely to develop chronic kidney disease or kidney failure than those who didn’t take the drugs.

The findings were to be presented Saturday at the annual meeting of the American Society of Nephrology (ASN), in New Orleans.

“This study demonstrates a significant association between the use of PPIs and increased risks of chronic kidney disease and kidney failure,” Thongprayoon said in an ASN news release.

He stressed that cause-and-effect wasn’t confirmed. However, Thongprayoon believes that doctors “should consider whether PPI therapy is indicated for patients. Chronic use of PPIs should be avoided if not really indicated.”

Two kidney specialists said the new research does have value.

“It is important to always evaluate potential side effects — not only of medications but of treatments and procedures in general,” said Dr. Ernesto Molmenti. He directs adult and pediatric kidney transplantation at Northwell Health in Manhasset, N.Y.

Dr. Maria DeVita helps direct kidney care at Lenox Hill Hospital in New York City. She noted that PPIs — some of which have gained over-the-counter status in recent years — “are one of the most commonly ingested medications worldwide.”

Also, DeVita said, “PPIs were originally used for a limited time, but now, people may continue to use them for years.”

While it remains to be proven that the drugs cause kidney trouble, “we should reconsider our prolonged use of PPIs from time to time to make sure that the benefits outweigh potential risks,” she said.

Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Source: HealthDay


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